TRT or not TRT - that is the question...

[Yarm]

I'm weighing my options again.

When I'm not on the TRT creams my level is 335 and I feel low and suffer insomnia.

After 3-4 days on 112.5 mg per day I feel good. Sleep well, libido on the rise, positive outlook.

By day 6-7 however things take a turn for the worse.

And then I stop TRT, fall back to my original state. Although one day after stopping I feel great. I've dine this for a 3 months now. Basically 50/50 on or off.

So there must be some middle ground, that I'm flying straight past.

What is the ideal level to maintain?

Last week I go back a blood test that put me at a level 1040 after 7 days treatment at 112.5 mg per day. The test was 4 hours after a dose of 37.5mg. This level was way too high and I don't feel good. Libido gone etc.

My GP asked me to stop when he got back the results two days later. I informed him I already had, and did the blood test earlier than was planned just so I could stop.

So two days later its all good. Three days not so good. So took 37.5mg to ease the withdrawal.

Five days later insomnia returns. And low spirits return. So again 37.5mg

I'm think my sweet spot might be 75mg.

When I'm not on T-cream I can raise my t-levels by going on a high fat/low carb diet (paleo). But I fear that's not a good solution. And it doesn't quite raise my levels enough, but possibly I need to try for a longer period. Levels will get to about 460. I feel stronger, but that diet is hard to maintain.

Thoughts?

 

[Megatron28]

Some good info in the following thread that should help you make a decision about TRT. Check it out.

http://www.steroidology.com/forum/t...therapy/681020-injections-vs-creams-gels.html

 

[Yarm]

Some good info in the following thread that should help you make a decision about TRT. Check it out.

steroidology.com/forum/testosterone-replacement-therapy/681020-injections-vs-creams-gels.html

Hi

I'm not sure which aspect of your previous responses to my queries you are referring to. Can you elaborate?

Thanks

 

[Megatron28]

Hi

I'm not sure which aspect of your previous responses to my queries you are referring to. Can you elaborate?

Thanks

Perhaps posts #29 and #33 for starters... Really any of the ones about you not having Hypogonadism and thus not requiring TRT will do. You just need to run PCT to get back to your previous healthy TT levels.

 

[Yarm]

Perhaps posts #29 and #33 for starters... Really any of the ones about you not having Hypogonadism and thus not requiring TRT will do. You just need to run PCT to get back to your previous healthy TT levels.

Thanks for you time here.

I'm looking to stop TRT as you suggest, however PCT is not an option for me.

It's I just stop cold turkey, with support from natural,supplements. Or drop down from 100mg cream to 25mg then 0.

I feel pretty bad when I come off the cream. After 4 days my spirits are very low.

 

[Megatron28]

Why is PCT not an option? Just order what you need from RUI (see banner ad at top of screen on Full Site) if your doc won't prescribe what you need.

 

[Yarm]

Why is PCT not an option? Just order what you need from RUI (see banner ad at top of screen on Full Site) if your doc won't prescribe what you need.

I'm not in the US. And I presumed a prescription is required. Perhaps not.

I found LIQUID TAMOX 50ML 20MG/ML. Would that suite? There is no indication as to how much to use and how often.

In the meantime would you suggest a reduced dose of TRT cream, or stop cold turkey?

Thanks

 

[halfwit]

I'm not in the US. And I presumed a prescription is required. Perhaps not.

I found LIQUID TAMOX 50ML 20MG/ML. Would that suite? There is no indication as to how much to use and how often.

In the meantime would you suggest a reduced dose of TRT cream, or stop cold turkey?

Thanks

I'm going to be a little blunt here, so please forgive my lack of tact that I usually possess. (still cooling down from the gym)

Your doctor is an idiot.

Worse, an idiot mucking around with your hormones.

Want to know why you felt like crap by day 7? Estradiol. That pesky "female" hormone that we men make from testosterone when the body sees a spike. This is how your body is trying to bring back homeostasis - it tries really hard to keep a certain ratio of estradiol to testosterone; which is not always for the best.

Creams and gels, while they are FANTASTIC money makers for doctors that get incentives from pharmaceutical reps, often have issues with creating such a problem - including an exaggerated increase in DHT. Did your doctor ever discuss with you the idea of injections? Injections are often far easier on this conversion, but they too may elevate estradiol, especially if you're overweight.

Your doctor should know this.

You can come off testosterone, sure. But I promise you that things will not get better as the years continue to move forward. They will get worse, much worse. This is because your body relies on an ample amount of testosterone to keep things like your metabolism working, your cardiovascular system healthy, and your insulin sensitivity happy.

I have seen first hand how this happens to climb downhill.

If I were you, I'd look into other options like an aromatase inhibitor (it prevents you from making so much estradiol), and give serious thoughts to injections. If your doctor is unwilling to take these into consideration, I would fire the idiot, and replace him with someone competent.

Please give that FAQ a read. It will arm you with vital information you NEED to know about hormone replacement therapy, and ensure you get the most out of things. If you truly insist on coming off, a PCT will make things the smoothest, but you're going to no better off than when you started, unless you simply had a "lazy pituitary", which your doctor should have ruled out.

My .02c

 

[Alpin]

Blood tests scare the doc..."too high"
He responds by "come off everything"...
Ridiculous...
How do these idiots get medical degrees again???
This is ridiculous..

 

[Megatron28]

Guys, Yarms Natty T is in the 500's. I don't think TRT is likely the answer for him.

 

[Yarm]

Want to know why you felt like crap by day 7? Estradiol. That pesky "female" hormone that we men make from testosterone when the body sees a spike. This is how your body is trying to bring back homeostasis - it tries really hard to keep a certain ratio of estradiol to testosterone; which is not always for the best.

My levels three hours after 35mg were:
Oestradial - 106 pmol/L (range is <160)
Testosterone 38.5 nmol/L (1100)
Calc. Free Testosterone - 1084 (range id 170 - 670)

I did ask about my oestrogen levels. He said they were OK.

Creams and gels, while they are FANTASTIC money makers for doctors that get incentives from pharmaceutical reps, often have issues with creating such a problem - including an exaggerated increase in DHT. Did your doctor ever discuss with you the idea of injections? Injections are often far easier on this conversion, but they too may elevate estradiol, especially if you're overweight.

TRT definitely helps my mood and focus and energy levels. However I've only ever lasted 10 days before feeling like its having the reverse effect.

Megatron suggests I don't need TRT, but at my 16 level I still suffered insomnia, low libido and lack of motivation and focus. These things all improve after four days. No depression thats for sure. But it doesn't last.

Earlier in the year I did a high fat diet plus was eating a lot of cabbage (no TRT). That felt like a good mix. I wasn't aware of it at the time but cabbage is an anti-oestrogen.

I've since learn I was allergic to fructose. So have yet to give a fructose free + paleo and no TRT mix a good run.

Right now I'm confused as to which way forward. I've cut back to 25mg per day (as opposed to 112mg per day) as a means to ease off of TRT. I using herbal supplements to help.

I can feel the low spirits returning, but this may be because my own production.

You can come off testosterone, sure. But I promise you that things will not get better as the years continue to move forward. They will get worse, much worse. This is because your body relies on an ample amount of testosterone to keep things like your metabolism working, your cardiovascular system healthy, and your insulin sensitivity happy.

I have seen first hand how this happens to climb downhill.

I think i can achieve a level of 16 or maybe 18 if i was to focus on diet. But for me that was still a low level. Do i just accept it now or fight it as long as possible? Im 49.
I was reading an article on Robb Wolf blog on testosterone. There was a guy there with a level of 600 achieved through diet and herbals, but still he opted for TRT and raised his levels to 850.
Presumably he wasnt satisfied with 600...

If I were you, I'd look into other options like an aromatase inhibitor (it prevents you from making so much estradiol), and give serious thoughts to injections.

Is there evidence for creams causing more aromatisation? It does have a large up and down swing during the day.

If your doctor is unwilling to take these into consideration, I would fire the idiot, and replace him with someone competent.

Im seeking a second opinion of someone more experience in the area.

Thanks

 

[halfwit]

Guys, Yarms Natty T is in the 500's. I don't think TRT is likely the answer for him.

I saw 335 followed by 460. I don't see mention whether those are peak or trough values though. Due to that, I'm basing my advice on symptoms. I'd hope that a doctor wouldn't prescribe TRT for someone that has a trough of almost 500ng/dL, but it's possible.

My levels three hours after 35mg were:
Oestradial - 106 pmol/L (range is <160)
Testosterone 38.5 nmol/L (1100)
Calc. Free Testosterone - 1084 (range id 170 - 670)

I did ask about my oestrogen levels. He said they were OK.

That's actually the top end of what many consider optimal estradiol - on 1/3rd your normal dose. While estradiol isn't a linear curve with testosterone, it's a fact that as test goes up, so does estradiol.

TRT definitely helps my mood and focus and energy levels. However I've only ever lasted 10 days before feeling like its having the reverse effect.

Time is the second part of the equation. As you continue with increasing test, the response compounds until the body is satisfied. Yes, at 35mg you may be better off, but I suspect it will climb still.

Megatron suggests I don't need TRT, but at my 16 level I still suffered insomnia, low libido and lack of motivation and focus. These things all improve after four days. No depression thats for sure. But it doesn't last.

There may be more going on here than just testosterone and estradiol. Have you ever had cortisol checked? Adrenal fatigue can creep up on the best of us.

Earlier in the year I did a high fat diet plus was eating a lot of cabbage (no TRT). That felt like a good mix. I wasn't aware of it at the time but cabbage is an anti-oestrogen.

I've since learn I was allergic to fructose. So have yet to give a fructose free + paleo and no TRT mix a good run.

Don't put a ton of faith into natural estrogen reducing foods. Most studies showing these effects required amounts of the food that frankly is often impractical to consume. Do they help? Sure. But is that the answer? Not unless you have a specific allergy or predisposition to such. Like your fructose allergy, which is pretty uncommon.

Right now I'm confused as to which way forward. I've cut back to 25mg per day (as opposed to 112mg per day) as a means to ease off of TRT. I using herbal supplements to help.

I can feel the low spirits returning, but this may be because my own production.



I think i can achieve a level of 16 or maybe 18 if i was to focus on diet. But for me that was still a low level. Do i just accept it now or fight it as long as possible? Im 49.
I was reading an article on Robb Wolf blog on testosterone. There was a guy there with a level of 600 achieved through diet and herbals, but still he opted for TRT and raised his levels to 850.
Presumably he wasnt satisfied with 600...

Easing off just prolongs the torture. Your HPTA doesn't gradually turn back on natural production. It's either off or on - sometimes there's a delay, but you can't get the best of both worlds I'm afraid.

If someone claims to achieve 600ng/dL naturally and opts for TRT, they're either selling something, or are mentally unstable. (or full of cow poopy)

Diet is VERY important, but unless it's recovery from a REALLY poor diet, I just can't see diet bringing someone back to eugonadal values. I've looked into natural means more than I care to think about - which adds insult to injury as I'm primary hypogonadal, and NOTHING can restore my natural production, short of a transplant.

Is there evidence for creams causing more aromatisation? It does have a large up and down swing during the day.


Im seeking a second opinion of someone more experience in the area.

Thanks

There are a tremendous amount of studies showing how transdermals tend to cause both higher estradiol and DHT conversion as they have to pass through the subcutaneous layer and fat to reach the blood stream. I'd link some, but you can find them easily enough with Google and pubmed.

I would certainly get that second look done. Just sounds like you've been trusting a professional a bit too much when it comes to your well-being. I know we should be able to, but this is far from the ideal world in which we can. Until then, keep reading and learning - that will ultimately be your best bet in finding the answers you seek.

I certainly wish you the best of luck in whatever path you choose.

 

[Megatron28]

Halfwit: see post #29 in Yarm's other thread. His Pre-TRT TT was 521ng/dl.

http://www.steroidology.com/forum/t...therapy/681020-injections-vs-creams-gels.html

 

[Yarm]

I saw 335 followed by 460. I don't see mention whether those are peak or trough values though. Due to that, I'm basing my advice on symptoms. I'd hope that a doctor wouldn't prescribe TRT for someone that has a trough of almost 500ng/dL, but it's possible.

I'd say my peak (non-trt) levels would be around 460-500. That's where they were at when I first tried TRT which I looked into after battling insomnia (in addition to low libido and motivation and depression).

That's actually the top end of what many consider optimal estradiol - on 1/3rd your normal dose. While estradiol isn't a linear curve with testosterone, it's a fact that as test goes up, so does estradiol.

The day before was the usual 112mg, spread out across the day.

I normally split it into three doses of 35mg each as all in one go makes me jittery.

So this blood test was 3 hours after morning dose.

Are you saying oestrogen of 106 is toward the higher end? Maybe that is the problem.

As mentioned I feel great after 4 days, but then it goes backward.

Possibly I'm overdosing.

Time is the second part of the equation. As you continue with increasing test, the response compounds until the body is satisfied. Yes, at 35mg you may be better off, but I suspect it will climb still.

I'm considering 50mg per day instead of 112, just to see how this goes and get my bloods done again to see if I've gone too high.
My dose was upped in the past as i said I tried it for a week and it did nothing but give me the jitters.
This was before I started splitting the dose, which helped a lot in that regard.

There may be more going on here than just testosterone and estradiol. Have you ever had cortisol checked? Adrenal fatigue can creep up on the best of us.

A year back i had high cortisol. But thats not the case now.

Don't put a ton of faith into natural estrogen reducing foods. Most studies showing these effects required amounts of the food that frankly is often impractical to consume. Do they help? Sure. But is that the answer? Not unless you have a specific allergy or predisposition to such. Like your fructose allergy, which is pretty uncommon.

Well something worked at the time. not sure what. I did try a similar diet afterward but to no avail.

Easing off just prolongs the torture. Your HPTA doesn't gradually turn back on natural production. It's either off or on - sometimes there's a delay, but you can't get the best of both worlds I'm afraid.

OK - I was under the assumption that the TRT i was on was meant to support or add to my own production.

If someone claims to achieve 600ng/dL naturally and opts for TRT, they're either selling something, or are mentally unstable. (or full of cow poopy)

It seemed a credible story to me. See "Paleo and Testosterone" - Rob Wolf
robbwolf.com/2011/11/02/paleo-and-testosterone/

February 21, 2011 (Paleo, Herbal Post Cycle Therapy Only): Got my blood work done. Holy shit! The herbals worked ***8211; well kind of. My total T, after 8 months of HPTA shut down, was sitting great at 600 ng/dl. Perfect! But***8230;..Free-Direct-T, pretty much bottom of the range at 10.3 (norm = 8.7-25.1 pg/ml). Interesting fact: cognitively I felt really good on the herbals, but energy was low. Kind of a mid-range point between the full benefits of TRT and just having crappy T levels all around. So not a bad place for someone who is just a little low. I would recommend this combination of herbs any time for a general guy just looking for a boost. But its not apparently going to solve the SHBG problem and raise the Free-T, SHBG just seems to be regulated in a completely different path. Also, as before, sleep was spot on, low stress, etc. I can***8217;t figure at all why Free-T would be that low. My endo asked if I would go off the herbs (figured I would adapt eventually and lose the benefits anyways) and see where things stood. I agreed, and scheduled follow up for April.

Diet is VERY important, but unless it's recovery from a REALLY poor diet, I just can't see diet bringing someone back to eugonadal values. I've looked into natural means more than I care to think about - which adds insult to injury as I'm primary hypogonadal, and NOTHING can restore my natural production, short of a transplant.

Diet does help me, but its a high fat, low carb diet and maybe not so good in the long run. High fat not being good for the heart and vascular system.

There are a tremendous amount of studies showing how transdermals tend to cause both higher estradiol and DHT conversion as they have to pass through the subcutaneous layer and fat to reach the blood stream. I'd link some, but you can find them easily enough with Google and pubmed.

OK - will look for them.

I would certainly get that second look done. Just sounds like you've been trusting a professional a bit too much when it comes to your well-being. I know we should be able to, but this is far from the ideal world in which we can. Until then, keep reading and learning - that will ultimately be your best bet in finding the answers you seek.

In Australia, its very difficult to find any practitioner as knowledgable as the people on here.
That said, there is one Integrative health practitioner who I'm seeing in two weeks.

I certainly wish you the best of luck in whatever path you choose.

Thanks

 

[Yarm]

Halfwit: see post #29 in Yarm's other thread. His Pre-TRT TT was 521ng/dl.

steroidology.com/forum/testosterone-replacement-therapy/681020-injections-vs-creams-gels.html

Yes, my level a year ago was this. Which as you say is not bad.

I could work toward getting back to that level, but even though it was normal I was not feeling great at all. Hence i got the checkup.

Previous to this my blood test result was 450. With Cortisol above the normal range.

I know that when I cut the TRT what I will be in for.

Even though I'm in the normal range, I don't feel normal.

On TRT i've none of the depression and grumpiness that I've live with for 5+ years now.

If TRT can improve my mood, possibly it will address my low libido. People here seem to suggest a return to a more positive outlook precedes a boost in libido.

Its coming up to day #15 for me now (with a few days off here and there) the last few days on a reduced dose (25mg versus 1112) and the libido does seem to have moved up ever so slightly if I'm not imagining things.

Megatron - If you knew me personally you'd know that Im not the sort to go in for TRT unless I tried everything else (diet, herbs, meditation, acupuncture, homoeopathics etc). And sometimes these in parallel. and if there was an improvement I'd stop the TRT just in case I'd found something that was working.

The best treatment to date seemed to be IF of a morning and lowish carb diet. But still its benefits were limited and somewhat short-lived. A boost in libido, but followed by a crash which i though was due to being too low carb (which gave me high cortisol in the past).

 

[Yarm]

Just to add to this.

The 25mg I'm doing now (I figured to just reduce my dosage) feels quite good emotionally. No highs and lows...

 

[halfwit]

Halfwit: see post #29 in Yarm's other thread. His Pre-TRT TT was 521ng/dl.

http://www.steroidology.com/forum/t...therapy/681020-injections-vs-creams-gels.html

Ohhhhhhhhhh. Gosh, now I realize that GP is an even bigger idiot than I thought previously. I give him credit for listening to his patients at least.

I'd say my peak (non-trt) levels would be around 460-500. That's where they were at when I first tried TRT which I looked into after battling insomnia (in addition to low libido and motivation and depression).


The day before was the usual 112mg, spread out across the day.

I normally split it into three doses of 35mg each as all in one go makes me jittery.

So this blood test was 3 hours after morning dose.

Are you saying oestrogen of 106 is toward the higher end? Maybe that is the problem.

As mentioned I feel great after 4 days, but then it goes backward.

Possibly I'm overdosing.



I'm considering 50mg per day instead of 112, just to see how this goes and get my bloods done again to see if I've gone too high.
My dose was upped in the past as i said I tried it for a week and it did nothing but give me the jitters.
This was before I started splitting the dose, which helped a lot in that regard.


A year back i had high cortisol. But thats not the case now.



Well something worked at the time. not sure what. I did try a similar diet afterward but to no avail.


OK - I was under the assumption that the TRT i was on was meant to support or add to my own production.


It seemed a credible story to me. See "Paleo and Testosterone" - Rob Wolf
robbwolf.com/2011/11/02/paleo-and-testosterone/






Diet does help me, but its a high fat, low carb diet and maybe not so good in the long run. High fat not being good for the heart and vascular system.


OK - will look for them.


In Australia, its very difficult to find any practitioner as knowledgable as the people on here.
That said, there is one Integrative health practitioner who I'm seeing in two weeks.


Thanks

Ok, new game plan. I think your issue is with dopamine, not testosterone. Jitters should have clued me in, but I'm essentially a dog chasing his own tail lately. I barely remember what I had for breakfast due to a crazy schedule. For that I apologize, as I now remember your other thread.

Jitters from a surge of testosterone can EASILY be attributed to the ENORMOUS uptake of serotonin and dopamine. It's also likely why you feel fantastic for a few days, then it peters out as you become adjusted to them. This also explains your issues with depression, as coming off drops those levels, and if you were deficient prior - it makes sense.

There are two things I'd have your doctor (or new doctor) look at: vitamin D, and your dopaminergic system. The latter has been treated with wellbutrin to a great extent (WAY better than SSRI use too), and may have you feeling right as rain if I'm right. If it's vitamin D, that's even easier and less invasive.

I'd look into those options as it definitely doesn't appear to be testosterone related. I do strongly urge you try to obtain SERMS to restart your natural production though. Going "cold turkey" may not be enough to bring things back to normal, and prolongs unnecessary suffering.

Yes, it's a very common misconception that adding testosterone will combine with what you produce naturally; unfortunately mommy nature is smarter than that.

Please let us know how things go. I'm sure there's a solution there that's just waiting to be found - just have to look in the right place.

 

[Megatron28]

Yarm: I am sure you answered this at one point in your various threads, but can you remind what your TSH pre-TRT looked like? I am curious about your thyroid function.

You checked prolactin too, right? Can you remind us of those results?

And when you were dieting, did you severely restrict calories for a long time? That can be suppressive to your thyroid and HPTA.

 

[Yarm]

Yarm: I am sure you answered this at one point in your various threads, but can you remind what your TSH pre-TRT looked like? I am curious about your thyroid function.

You checked prolactin too, right? Can you remind us of those results?

And when you were dieting, did you severely restrict calories for a long time? That can be suppressive to your thyroid and HPTA.

Hi

Figures pre TRT were:
Free T4 - 12.5 pmol/L (9.0-19)
TSH - 1.4 mlU/L (0.3 - 3.5)
FSH <2 IU/L (< 10)
LH 3 IU/L
Vit. D - 48 nmol/L
Prolactin 178 mlU/L (<500)
Testosterone - 18.1 nmol/L (11-40)
SHGB 24 nmol/L
Free Testosterone - 440 pmol/L
Oestradiol 71 pmol/L

Symptoms were depression, low libido, low motivation, poor focus.

The last time I went off for 7 days to get a blood test done, my t level came back at 11.9. Still in normal range. I went back on the TRT straight after.

I'm a little nervous of falling back into a depressive state however.

The TRT does work for me on some level, and clears the depression in a day or two.

Issues started when I cut out grains from my diet. And increased fruit. But fructose turned out to be the problem. I was always a bit of a sugar addict.

So have lost weight on this diet. About 10kg in two years. I'm 76kg, not at all overweight.

Why would that be?

 

[Alpin]

Did u even have a sleep study done before TRT ?
The symptoms u list are not all related to Testosterone always.
It's easy to say "ya more test will help"...
Have u ever used steroids in the past?